SREB

1. SREB Council of Collegiate Education for Nursing The Ties that Bind

2. Coalition Building as a Mechanism to Create Trust, Collaboration & Strategic Alliances Alexia Green RN, PhD, FAAN Professor & Dean Emeriti Texas Tech University Health Sciences Center Lubbock, Texas

3. Objectives: • Differentiate between partnerships & coalitions • Analysis the stages of political development in nursing profession. • Discuss the role of “partnership & coalition building” in developing the profession. • Identify and integrate characteristics of effective partnership & coalition building into organizational strategies to improve nursing education.

4. Partnership Defined • A partnership is an arrangement where parties agree to cooperate to advance their mutual interests • Partnerships present the involved parties with special challenges that must be navigated unto agreement. Overarching goals, levels of give-and-take, areas of responsibility, lines of authority and succession, how success is evaluated and distributed, and often a variety of other factors must all be negotiated. Lasker, Weiss & Miller(2001)

5. Coalition Defined: • “ A group of organizations whose members commit to an agreed-on purpose & shared decision making to influence an external institution or target goal, while each member organizations maintains its own autonomy.” Mizzrahi& Rosenthal (2001) • “Coalitions are made up of multiple entities (generally other organizations) which in turn are made up of multiple individual actors who are in pursuit of specific goals”. The California Endowment(2009)

6. Understanding the Stages of Nursing’s Political Development: Cohen, et. al. (2011) • Reactive with a focus on nursing issues • Learning the language • Minimal political awareness – occasional participation in partnerships/coalitions • Isolated impact on policy, minimal impact on community/society • Reactive to broader issues • Language focuses on “nurse jargon” • Some partnerships emerge with focus on nursing • Some impact related to nursing issues Stage 1 Stage 2

7. Understanding the Stages of Political Development: Cohen, et. al. (2011) • Proactive engagement in nursing & other issues • Using parlance & rhetoric focused on broader issues beyond nursing • Participate in multiple partnerships & coalitions • Nurses appointed to committees/boards focused on health related issues • Proactive leadership & agenda-setting for broad-range of social & policy issues • Introducing terms that reorder the debate • Initiating partnerships & coalitions beyond nursing • Nurses sought after to fill multiple boards addressing multiple societal issues Stage 3 Stage 4

8. When should you form Partnerships or join Coalitions? • First Question to be Addressed is not Evidenced Based – But Is A Strategic Decision • Context Specific • “When going it alone” is not an option due to lack of resources, influence or impact • Results in greater social impact • Requires Strategic Engagement Butterfield, K., Reed, R., & Lemak, D. (2004).

9. Seven Stages of Development • Mobilization • Establishing Organizational Structure • Building Capacity for Action • Planning for Action • Implementation • Refinement • Institutionalization Raynor (2011)

10. Capacities of Effective Partnership/Coalition Members: • Skills/knowledge to work collaboratively • Commit to the defined action as well in name • Ability to articulate what you bring to the table (time, resources, access, relationships, reputation, expertise, etc.) • Ability to articulate what you want from the table • Willingness to share resources • Willingness to openly identify conflicts between the individual organization/s and partners • Willingness to share power/credit

11. Capacities of Effective Partnership/Coalition Members Cont: • Willingness to speak as one • Willingness to explore alternative ideas and approaches • Willingness to dedicate staffing to implement assigned tasks • Willingness to commit for an extended and relevant period of time • Understanding how your issue/goal fits into a broader network of issues & shared goals Raynor (2011)

12. Benefits of Developing & Participating in Partnerships & Coalitions • Networking • Information Sharing • Access to Resources • Resource Pooling • Involvement in Important Cause or Strategy • Shared Mission • Ability to Attained Desired Outcomes • Enhanced Visibility and Power in Numbers • Enjoyment of collaboration & camaraderie • Ability to Build Skills

13. Effectiveness: • In addition to core capacities – organizational culture plays a role in how the partnership functions • Culture is the unique history, language, organizational structure, and set of values and beliefs of an organization. • Effective Partnership Cultures must have: • Trust • Respect • Safe Dissent • Unity • Sensitivity to Power Differentials Lasker, R., Weiss, E., & Miller, R. (2001)

14. Partnership Exemplar # 1: Seton Healthcare Family Austin & Texas Hill Country, Texas A Regional Partnership

15. Seton HC Family of Hospitals : • A member of the Ascension Healthcare System • 11 hospitals, ambulatory facilities: home care and hospice services • Four ANCC Magnet Designated Hospitals since 2002 • Five Pathway to Excellence Hospitals

16. Addressing the Seton Nursing 2015 Strategic Direction…”nurses with the right skills” Pipeline and Professional Development Partnerships Seton 10.23.12

17. Seton Healthcare Family Partnerships The Health Industry Steering Committee (HISC) Seton Healthcare Family co-leads a 13-year community partnership of secondary and post secondary education, workforce intermediaries and clinical agencies to meet the needs of all stakeholders • Establishes community standards for student placements, background checks/screenings, immunizations, faculty competency standards, preceptor education, etc. • Established the web based Central Texas Scheduling System to coordinate and manage student cohort placementin the 10 county region.

18. Mission of The Clinical Education Center (CEC) The Clinical Education Center at Brackenridge is committed to: • Supporting interprofessional clinical education in an immersive learning environment • Facilitating a pipeline of well-qualified health practitioners for Central Texas • Conducting evaluations and research relative to CEC activities

20. Seton Healthcare Family Partnerships Seton Healthcare Family Contribution to area nursing schools • From 2002 – 2012 > $2,900,000 Austin Community College MOUs 2002- September 2010 • Funding support to expand capacity by 54% • Provided faculty and lab equipment/supplies • Provided Seton with 10 preferred slots in each Fall admissions cycle • Provides for 50 Seton Associates to register early for pre-nursing courses each semester MOU August 2007-2011 • Providing space at Seton’s Clinical Education Center (CEC) and faculty support • Approximately 200 ACC nursing students enrolled at the CEC

21. Seton Healthcare Family Partnerships University of Texas Austin MOUs 2007-2013 • Seton’s Nursing Research Fellowship and Writing for Publication Workshops supported by The UT Austin School of Nursing • Seton funds supported additional faculty to increase enrollment • Scholarships student enrolling in the ADN-BSN Program (up to $10,000/student) • Support for development of online courses for the ADN-BSN program • Provides part-time advisor for ADN-BSN Program • Provided for Pediatric Nurse Practitioner faculty in support of the ACPNP Post-Master’s program.

22. Seton Healthcare Family Partnerships Texas Tech Health Science Center School of Nursing • Second Degree Program rents clinical skills labs, simulation labs and computer lab space at the Clinical Education Center • Seton support for more permanent presence in Central Texas • Fills niche market for Second Degree Students • Provides MSN and DNP Education for Seton nurses with special emphasis on Leadership Concordia Lutheran University School of Nursing • Rents clinical skills labs, simulation labs and computer lab space at the Clinical Education Center

23. Seton HC Family of Hospitals Partnership Grew to Coalition –What strategies and tactics did Seton deploy to succeed?What are the evidence-based indicators for success?Let’s Dive Deeper into What Makes a Partnership or a Coalition Successful

24. Building a Partnership Culture : • Focus on important needs • Make the Partnerships a Win-Win • Adopt a Shared Vision • Negotiate a Formal Agreement • Ensure Good Communication • Ensure the Partnership is Owned by Your Whole Organization • Maintain an Environment of Trust • Leave Your Ego and Control at the Door

25. Building a Partnership Culture Cont: • Understand Each Partner's Mission and Organizational Culture • Utilize Strengths of Each Partner • Build Step by Step • Constantly Seek Out and Adopt Best Practices • Diversify Your Funding Sources • Celebrate Success • Respect the Right to Disagree; Act on a Consensus Basis

26. Culture Trumps Strategy (or Capacity) • In addition to core capacities – organizational culture plays a role in how the coalition functions • Culture is the unique history, language, organizational structure, and set of values and beliefs of an organization. • Effective Coalition Cultures must have: • Trust • Respect • Safe Dissent • Unity • Sensitivity to Power Differentials

27. LeadershipCapacities • Shared purpose and vision which builds cohesion • Common goal destination • Clear value proposition • Formalized set of rules/procedures • A “core” leadership team • A commitment to action • Transparent consensus decision-making processes • Strategically developed and engaged partners/members

28. Pros & Cons of Consensus Decision-Making • Increases commitment • Empowerment • Participation • Overcome resistance to change • General satisfaction with decisions • Builds morale • Theoretical message of equality • Difficulty defining specific tasks • Slow/Time consuming • Waiting to take action until all have spoken rather than when a decision has been made Pros Cons

29. For Success: Tactical Support a Must

30. Understanding the Difference Between Strategic & Tactical Thinking • Strategic = “Doing the Right Thing” • Tactical = “Doing Things Right” Leadership Management

31. The Critical Difference

32. Strategic Thinking: • Clarifying the vision & direction of the whole • Must have clear success “measures” • About identifying relationships which support the partners/coalition vision • About identifying leverage points for change • Disciplined thinking about desired outcomes • Clarifies goals & outcomes

33. Tactical Support & Operations Key to Coalition Success: • Provides support for achievement of the Strategic Plan • Focuses on planned or ad hoc activities • Requires resources for support of activities focused on implementation of strategies & achievement of goals • Tactics are decided by the “operations team” • Tactics may be decided by more than one “operating team” in a Coalition

34. Adaptive Capacities of Successful Partnerships: • Ability to monitor the policy environment • Effective & action-oriented planning • Ongoing monitoring & evaluation • Clear measures of goal destination – use of benchmarks • Measures of value proposition • Procurement of resources (financial & in-kind from both partners & external sources)

35. Management Capacities: • Frequent & productive communications • Facilitate language differences • Managing member participation • Delivery on reciprocity/expectations • Clear task & goal assignments • Clarity around member & staff roles • Ability to manage conflict • Careful record-keeping – including tracking of progress Foster-Fishman, P., Berkowitz, S., Lounsbury, D., Jacobson, S., & Allen, N. (2001).

36. Technical Capacities: • Coalition staffing • Communication skills • Policy/advocacy expertise • Tangible non-human resources (e.g. space, equipment, website, social media) • Resource development skills (financial & human resources) Foster-Fishman, P., Berkowitz, S., Lounsbury, D., Jacobson, S., & Allen, N. (2001)

37. Funding a Partnership or Coalition: What is value to Funder? • Does partnership goals align with funder’s goals? • Can the partners articulate its value proposition? • Do the partners represent the breadth of constituencies affected by the issue? If not is there a good rationale • How will the funder hold the partners accountable?

38. Funding a Partnership or Coalition: What is the partners ability to do the work? • Can the partners demonstrate capacity to do the work? • Where are the resource gaps between what partners provide & what the partnership needs in order to do its work?

39. Funding a Partnership or Coalition: Is the partnership sustainable? • Is there transparency & equity? • Is the partnership funded at sufficient levels to get the job done? • Is there a “value proposition” beyond the funder’s relationships & funding draw?

40. Funding a Partnership or Coalition: Should the partners incorporate? • Formal incorporation should be discouraged except in the most extreme circumstances. • If incorporation is pursued it should not be dependent upon a single funding source • Funders have several options in funding non-incorporated partnerships & coalitions

41. Partnership Exemplar # 2

43. Campaign Vision All Americans have access to high-quality, patient-centered care in a health care system where nurses contribute as essential partners in achieving success 6

44. Nursing Must be Considered a Societal Issue! RWJF/AARP seeking support from: Health professionals Philanthropies Payers Educators Consumer advocates Hospitals and health systems Business Public health agencies Policy-makers 22

45. Campaign Strategies Diverse Stakeholders Action Coalitions Policy-makers RWJF AARP Advisory Committee Research, Monitoring, Evaluation Communications Grantmaking 21

46. Campaign for Action State Involvement 23

47. Our Commitment to Advance the Health of Texans through Nursing “Better Care, Better Health, Reduced Cost”

48. History of Texas Team Green, A. et. al. (2011). Building academic capacity through statewide partnerships. Journal of Professional Nursing, 27: e50 – e57.

49. Texas Team Addressing Nursing Education Using Regional Model for New Texas IFN Team

50. New Texas Team